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The four major structural components of our face are skin, fat, muscle and bone. As we age, volume loss in these areas contributes to the visible signs of aging. Dermal fillers may help.

Over time, age-related bone loss in the face can lead to retraction of the jaw line, descent of the nose and loss of high cheekbones.

The facial muscles also decrease in volume and elasticity, and deflation and movement of facial fat further accentuates the signs of aging.

Finally, the skin stretches and loses elasticity. Compounded by the loss of scaffolding provided by fat, muscle and bone, these changes lead to wrinkles, sagging skin and other familiar signs of aging.

Dermal fillers, an injectable treatment performed in a doctor’s office, can help smooth lines and replenish lost volume, restoring a more youthful appearance.

Many types of fillers

Dermal fillers are soft, gel-like substances that are injected under the skin. They can address a number of common concerns, including smoothing of under-eye circles, lifting of cheekbones, volumization of the lips, smoothing of lip lines and nasolabilal folds (the creases that run from the side of the nose to the corners of the mouth), and rejuvenation of the hands.

Dermal fillers can be composed of a variety of substances, some naturally occurring and some synthetic. One of the most common compounds used in dermal fillers is hyaluronic acid (HA).

HA is a naturally occurring substance found in our skin, and it plays a major role in keeping skin hydrated and voluminous. HA fillers, depending on their specific chemical makeup, can last from six months to much longer before being gradually absorbed by the body.

One of the main benefits of HA fillers, aside from their natural appearance when injected, is that they can be dissolved by a special solution in case of an adverse event, or if the person dislikes the appearance. Also, most HA fillers are premixed with lidocaine, a numbing agent, to maximize comfort during treatment.

Other available dermal fillers include those made from calcium hydroxylapatite, poly-L-lactic acid, polymethyl methacrylate, and autologous fat (fat that is transplanted from another part of your body).

Calcium hydroxylapatite is a mineral-like compound naturally found in human bones. It has been used in dentistry and reconstructive plastic surgery for years with a long track record of safety.

Poly-L-lactic acid is a synthetic filler that helps stimulate collagen production. This filler is different from other fillers because its results are gradual. Volumization occurs over several months as it stimulates the body to produce collagen.

Polymethyl methacrylate is a semi-permanent filler. While it is more durable compared to other more readily biodegradable fillers, it has potential complications such as forming lumps or being visible under the skin.

Get professional advice

Each of these substances has its own pros and cons, as well as a unique density, longevity and texture, which means a particular material may be more or less suited to a specific area of the face or desired result.

Choosing the right type of dermal filler requires the guidance of an experienced, board-certified dermatologist or cosmetic surgeon with a thorough understanding of facial anatomy and familiarity with the variety of available fillers and their respective injection techniques.

A medical professional will thoroughly evaluate any specific areas of concern, understand what you hope to get out of the procedure, and review what to expect before, during and after the treatment to ensure the best cosmetic outcome.

Avoid black market fillers

Dermal filler procedures can be expensive, which has prompted some consumers to turn to the black market online to purchase do-it-yourself fillers.

The Food and Drug Administration has issued an official warning urging consumers to “never buy dermal fillers on the Internet. They may be fake, contaminated or harmful.”

Dermal fillers are safe and effective in the right hands. Finding the right physician to perform your dermal filler procedure is key.

Don’t be afraid to ask about training and certification to ensure you’re receiving care from a board-certified, experienced dermatologist or cosmetic surgeon.

With the right preparation and communication with your physician, you can achieve natural, beautiful and safe results.

Kristina Liu, M.D., M.H.S., is a contributor to Harvard Health Publications.

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